SMDA was contacted by a physician to evaluate a repayment request by a well known Long Term Disability Insurer. The doctor had been diagnosed with a medical condition which interfered with the surgical aspects of his practice. The disability insurer convinced the doctor that he was only residually disabled and intermittently paid a residual disability benefit whenever he had a qualifying loss of earnings each month. The Disability insurer took this position because the doctor continued performing a portion of the office-based tasks associated with his specialty. This went on for more than 5 years. Eventually the disability insurer requested repayment when it determined that it had mistakenly overpaid benefits for several months.
Upon investigation, counsel determined that the physician actually was totally disabled under the several policies he had in place which were purchased when he completed his residency several decades earlier. (In counsel’s experience, the older the policy the better the language is for the claimant.) SMDA also learned the physician/client actually had multiple disability policies with several different Long Term Disability insurers. Counsel was able to favorably resolve the doctor’s claims with each of the LTD Insurers. All because of the disability insurer’s initial repayment request.
If you are a physician who has been forced to curtail the nature of your practice but your disability insurer has refused to honor your claim for Total Disability benefits please contact SMDA for a free consultation.